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CardioVascular and Interventional Radiology

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01-02-2012 | Clinical Investigation

Percutaneous Vertebroplasty in Multiple Myeloma: Prospective Long-Term Follow-Up in 106 Consecutive Patients

Authors: Giovanni Carlo Anselmetti, Antonio Manca, Filippo Montemurro, Joshua Hirsch, Gabriele Chiara, Giovanni Grignani, Fabrizio Carnevale Schianca, Antonio Capaldi, Delia Rota Scalabrini, Elena Sardo, Felicino Debernardi, Gabriella Iussich, Daniele Regge

Published in: CardioVascular and Interventional Radiology | Issue 1/2012

Abstract

Purpose

Percutaneous vertebroplasty (PV) is a minimally invasive procedure involving the injection of bone cement within a collapsed vertebral body. Although this procedure was demonstrated to be effective in osteoporosis and metastases, few studies have been reported in cases of multiple myeloma (MM). We prospectively evaluated the safety and efficacy of PV in the treatment of vertebral compression fractures (VCFs) resulting from MM.

Materials and Methods

PV was performed in 106 consecutive MM patients who had back pain due to VCFs, the treatment of which had failed conservative therapies. Follow-up (28.2 ± 12.1 months) was evaluated at 7 and 15 days as well as at 1, 3, 6, 12, 18, and every 6 months after PV. Visual analog scale (VAS) pain score, opioid use, external brace support, and Oswestry Disability Index (ODI) score were recorded.

Results

The median pretreatment VAS score of 9 (range 4–10) significantly (P < 0.001) decreased to 1 (range 0–9) after PV. Median pre-ODI values of 82% (range 36–89%) significantly improved to 7% (range 0–82%) (P < 0.001). Differences in pretreatment and posttreatment use of analgesic drug were statistically significant (P < 0.001). The majority of patients (70 of 81; 86%) did not use an external brace after PV (P < 0.001).

Conclusion

PV is a safe, effective, and long-lasting procedure for the treatment of vertebral compression pain resulting from MM.

Raab MS, Breitkreutz I, Anderson KC (2007) Targeted treatments to improve stem cell outcome: old and new drugs. Bone Marrow Transplant 40(12):1129–1137PubMedCrossRef

Bjorkstrand B, Gahrton G (2007) High-dose treatment with autologous stem cell transplantation in multiple myeloma: past, present, and future. Semin Hematol 44(4):227–233PubMedCrossRef

von Lilienfeld-Toal M, Hahn-Ast C, Furkert K et al (2008) A systematic review of phase II trials of thalidomide/dexamethasone combination therapy in patients with relapsed or refractory multiple myeloma. Eur J Haematol 81(4):247–252CrossRef

Curran MP, McKeage K (2009) Bortezomib: a review of its use in patients with multiple myeloma. Drugs 69(7):859–888PubMedCrossRef

Musto P, Petrucci MT, Bringhen S et al (2008) A multicenter, randomized clinical trial comparing zoledronic acid versus observation in patients with asymptomatic myeloma. Cancer 113(7):1588–1595PubMedCrossRef

Callander NS, Roodman GD (2001) Myeloma bone disease. Semin Hematol 38(3):276–285PubMedCrossRef

Rosen LS, Gordon D, Tchekmedyian NS et al (2004) Long-term efficacy and safety of zoledronic acid in the treatment of skeletal metastases in patients with nonsmall cell lung carcinoma and other solid tumors: a randomized, phase III, double-blind, placebo-controlled trial. Cancer 100(12):2613–2621PubMedCrossRef

Saad F, Gleason DM, Murray R et al (2004) Long-term efficacy of zoledronic acid for the prevention of skeletal complications in patients with metastatic hormone-refractory prostate cancer. J Natl Cancer Inst 96(11):879–882PubMedCrossRef

Lipton A, Theriault RL, Hortobagyi GN et al (2000) Pamidronate prevents skeletal complications and is effective palliative treatment in women with breast carcinoma and osteolytic bone metastases: long term follow-up of two randomized, placebo-controlled trials. Cancer 88(5):1082–1090PubMedCrossRef

10.

de Wit R, van Dam F, Loonstra S et al (2001) The Amsterdam pain management index compared to eight frequently used outcome measures to evaluate the adequacy of pain treatment in cancer patients with chronic pain. Pain 91(3):339–349PubMedCrossRef

11.

Meuser T, Pietruck C, Radbruch L, Stute P, Lehmann KA, Grond S (2001) Symptoms during cancer pain treatment following WHO guidelines: a longitudinal follow-up study of symptom prevalence, severity and etiology. Pain 93(3):247–257PubMedCrossRef

12.

Galibert P, Deramond H, Rosat P, Le Gars D (1987) Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 33(2):166–168PubMed

13.

Watts NB, Harris ST, Genant HK (2001) Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty. Osteoporos Int 12(6):429–437PubMedCrossRef

14.

Anselmetti GC, Corrao G, Monica PD et al (2007) Pain relief following percutaneous vertebroplasty: results of a series of 283 consecutive patients treated in a single institution. Cardiovasc Intervent Radiol 30(3):441–447PubMedCrossRef

15.

Barragan-Campos HM, Vallee JN, Lo D et al (2006) Percutaneous vertebroplasty for spinal metastases: complications. Radiology 238(1):354–362PubMedCrossRef

16.

Masala S, Anselmetti GC, Marcia S, Massari F, Manca A, Simonetti G (2008) Percutaneous vertebroplasty in multiple myeloma vertebral involvement. J Spinal Disord Techn 21(5):344–348CrossRef

17.

Dudeney S, Lieberman IH, Reinhardt MK, Hussein M (2002) Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma. J Clin Oncol 20(9):2382–2387PubMedCrossRef

18.

Gangi A, Guth S, Imbert JP, Marin H, Dietemann JL (2003) Percutaneous vertebroplasty: indications, technique, and results. Radiographics 23(2):e10PubMedCrossRef

19.

Lieberman IH, Dudeney S, Reinhardt MK, Bell G (2001) Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 26(14):1631–1638CrossRef

20.

McDonald RJ, Trout AT, Gray LA, Dispenzieri A, Thielen KR, Kallmes DF (2008) Vertebroplasty in multiple myeloma: outcomes in a large patient series. AJNR Am J Neuroradiol 29(4):642–648PubMedCrossRef

21.

Kose KC, Cebesoy O, Akan B, Altinel L, Dincer D, Yazar T (2006) Functional results of vertebral augmentation techniques in pathological vertebral fractures of myelomatous patients. J Natl Med Assoc 98(10):1654–1658PubMed

22.

Astolfi S, Scaramuzzo L, Logroscino CA (2009) A minimally invasive surgical treatment possibility of osteolytic vertebral collapse in multiple myeloma. Eur Spine J 18(Suppl 1):115–121PubMedCrossRef

23.

Ramos L, de Las Heras JA, Sanchez S et al (2006) Medium-term results of percutaneous vertebroplasty in multiple myeloma. Eur J Haematol 77(1):7–13PubMedCrossRef

24.

Gangi A, Kastler BA, Dietemann JL (1994) Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy. AJNR Am J Neuroradiol 15(1):83–86PubMed

25.

Aebli N, Krebs J, Davis G, Walton M, Williams MJ, Theis JC (2002) Fat embolism and acute hypotension during vertebroplasty: an experimental study in sheep. Spine 27(5):460–466PubMedCrossRef

26.

Krebs J, Ferguson SJ, Hoerstrup SP, Goss BG, Haeberli A, Aebli N (2008) Influence of bone marrow fat embolism on coagulation activation in an ovine model of vertebroplasty. J Bone Joint Surg Am 90(2):349–356PubMedCrossRef

27.

Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM (2001) Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94(2):149–158PubMedCrossRef

28.

Monticone M, Baiardi P, Ferrari S et al (2009) Development of the Italian version of the Oswestry disability index (ODI-I): a cross-cultural adaptation, reliability, and validity study. Spine (Phila Pa 1976) 34(19):2090–2095CrossRef

29.

Vogel MN, Weisel K, Maksimovic O et al (2009) Pathologic fractures in patients with multiple myeloma undergoing bisphosphonate therapy: incidence and correlation with course of disease. AJR Am J Roentgenol 193(3):656–661PubMedCrossRef

30.

Lecouvet F, Richard F, Vande Berg B et al (1997) Long-term effects of localized spinal radiation therapy on vertebral fractures and focal lesions appearance in patients with multiple myeloma. Br J Haematol 96(4):743–745PubMedCrossRef

31.

Hiwatashi A, Westesson PL, Yoshiura T et al (2009) Kyphoplasty and vertebroplasty produce the same degree of height restoration. AJNR Am J Neuroradiol 30(4):669–673PubMedCrossRef

Title: Percutaneous Vertebroplasty in Multiple Myeloma: Prospective Long-Term Follow-Up in 106 Consecutive Patients
Authors: Giovanni Carlo Anselmetti
Antonio Manca
Filippo Montemurro
Joshua Hirsch
Gabriele Chiara
Giovanni Grignani
Fabrizio Carnevale Schianca
Antonio Capaldi
Delia Rota Scalabrini
Elena Sardo
Felicino Debernardi
Gabriella Iussich
Daniele Regge
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 1/2012
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-011-0111-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Percutaneous Vertebroplasty in Multiple Myeloma: Prospective Long-Term Follow-Up in 106 Consecutive Patients

Abstract

Purpose

Materials and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusion

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